Before you get your knickers in a bunch, hear me out. I’m not talking about people with severe mental illness (SMI), complex trauma, or personality disorders. Of course there are always exceptions and it always depends on each client’s unique situation. However, the most common reasons people seek out therapy for: depression, anxiety, stress, life adjustment/transitions, does not require long term individual therapy.
Long term, supportive therapy is like going to the Spa.
Imagine going to a luxurious spa. You are pampered, soothed, and made to feel years younger and lighter. You leave there feeling better, calmer, and more focused. Nice, right? If only this feeling would last. Soon the hectic pace of your week catches up to you and the stress creeps back up. Before you know it, you’re tired and trying to figure out how soon you can afford to go back to the spa. It didn’t last and you have to keep going back to continue enjoying its benefits. Long term supportive therapy can turn into this. You go to session and you feel validated, you feel supported, you finally feel understood. Your therapist really gets you. You update her on all the things you’ve been doing, she helps you clear your head and think things through. Only over time, not much is changing. Moreover, you might begin waiting before trying things or making decisions until you can talk to your therapist. That’s a problem because you are now becoming dependent on your therapist. I once had a couple do this. They learned and practiced active listening skills in session with me and did very well. However, they struggled to practice this on their own at home. So they started to wait until they could see me to then hash out all their problems. They would avoid issues during the week, bottle it up, and wait until they could see their therapist to then work on their problems and their communication. This wasn’t good for them as they were not making any real changes outside of therapy and they were not practicing the skills they were learning in therapy. We had to change our therapy approach to focus on making changes outside of therapy. So just like a spa, long term therapy can turn into a supportive relationship where you have to keep going back to continue receiving the benefits while not much else has changed in your day to day life.
Short term, goal focused therapy is like going to Physical Therapy.
If you’ve ever broken a bone or been through physical rehab you know it is not easy. Your physical therapist wears you out, stretches you just beyond your limit, scolds you when you haven’t done your practice exercises at home (they always know!), challenges you, and often makes you break a sweat. When you’re done you feel accomplished but also exhausted and oh so very sore. Every week builds on what you learned the week before, and you leave every session with clear exercises to practice during the week. By the end of your physical therapy your strength has improved, your range of motion increased, and your endurance gotten better. You have achieved a lot of real changes that you can see and feel and you graduate from physical therapy. Maybe you then set new goals for yourself and get a physical trainer at a gym in order to keep progressing, but you no longer need your physical therapist the way you did when you first started your rehab. Short term, goal focused therapy is similar. With a deadline in sight you are more likely to push harder in working towards your goals. Therapy can be tough at times and stretch you in ways you’re not used to. Such as talking about the very emotions and memories your spend most of your time trying to avoid dealing with. You might leave session feeling heavy and emotionally sore. You will have goals and practice assignments during the week to keep working on what you’ve been learning in session. With time and practice you get better. Your emotional muscles strengthen and you can now tolerate more, your range of options to chose from when you get triggered have increased and you’ve gotten better managing your stress. You have made real changes and you can see the difference in your life. But you had to work for it, and most of that work occurred outside of the therapy session.
Becoming Your Own Therapist
My goal for all my clients is to learn how to become their own therapist. I am thrilled when my clients start to say things like “I already know what you’re going to say” or “I could almost hear you telling me to challenge my thought.” This tells me they are internalizing what they have been learning. It is also a sign to evaluate where we are in therapy and if it’s time to start talking about termination. After all, if they already know what I’m going to say, maybe it’s time to try and leave the nest and fly on their own. Or perhaps, I’ve reached the limit of the value I can provide and it’s time to seek out another therapist who has different strengths and perspectives than I do.
I feel like our society is creating a phenomena where more and more people are genuinely socially isolated. Social media is not a substitute for real, in-person, social support. This positions many therapists as the only “friend” and “confidant” a client has. When this is the case, I think it is very important that learning to how to create supportive social relationships be a part of the therapy goals. This way the client can begin to foster these relationships in their own life (which requires change) so they don’t come to depend solely on the therapist to play that role. I actually had a client say that to me in session once. We were talking about learning to make friends in order to eventually get social support and she said: “I don’t need too; I have you to talk to.” This was a problem; it is not healthy for me to be the only person she could talk to. Our treatment focus had to address the fear and anxiety she experienced at the thought of changing and putting herself out there in order to meet people; after all you have to first meet people before you can make friends. Fortunately, we had a deadline; she knew she couldn’t keep seeing me week after week with no end in sight, and this helped give her the extra kick she needed to take some chances and start making some changes in her life.
What Happens After Therapy?
When you complete a round of therapy then what? Is that it? You did your short term, goal focused therapy and that’s all you get? Of course not! For many people that really is all they need. Some people need booster sessions every few months to brush up on their skills. And for some, all the new changes they’ve made now bring new challenges. Challenges they have not faced before and could use some help in navigating. Of course it’s ok to go back to therapy. The key difference here is that you are making changes and you have specific goals you want to work towards. I had a PTSD patient who went through this. We completed a very difficult and emotionally draining course of Prolonged Exposure Therapy. He worked through his traumas, made a lot of positive changes in his life and completed therapy feeling much, much better. One year later he comes back to therapy feeling ashamed to be there. He explained he started college and was feeling overwhelmed with the crowds and workload. He felt he “should have” been able to handle it because he already did therapy. I explained that he was facing something completely new! A year before he couldn’t even go to the grocery store and now he was going back to college! That was amazing! So of course it was OK to go back to therapy. He had new goals and new challenges. He leveled up. Just like a student who learned arithmetic, he had graduated onto algebra and needed a teacher again. That’s the beauty of life. We always have a chance to continue to grow and learn.